title: Hepatitis B virus transmissions associated with a portable dental clinic, West Virginia, 2009.
abstract: BACKGROUND
  Although hepatitis B virus (HBV) transmission in dental settings is rare, in 2009 a cluster of acute HBV infections was reported among attendees of a two-day portable dental clinic in West Virginia.
  
  
  METHODS
  The authors conducted a retrospective investigation by using treatment records and volunteer logs, interviews of patients and volunteers with acute HBV infection as well as of other clinic volunteers, and molecular sequencing of the virus from those acutely infected.
  
  
  RESULTS
  The clinic was held under the auspices of a charitable organization in a gymnasium staffed by 750 volunteers, including dental care providers who treated 1,137 adults. Five acute HBV infections-involving three patients and two volunteers-were identified by the local and state health departments. Of four viral isolates available for testing, all were genotype D. Three case patients underwent extractions; one received restorations and one a dental prophylaxis. None shared a treatment provider with any of the others. One case volunteer worked in maintenance; the other directed patients from triage to the treatment waiting area. Case patients reported no behavioral risk factors for HBV infection. The investigation revealed numerous infection control breaches.
  
  
  CONCLUSIONS
  Transmission of HBV to three patients and two volunteers is likely to have occurred at a portable dental clinic. Specific breaches in infection control could not be linked to these HBV transmissions.
  
  
  CONCLUSIONS
  All dental settings should adhere to recommended infection control practices, including oversight; training in prevention of bloodborne pathogens transmission; receipt of HBV vaccination for staff who may come into contact with blood or body fluids; use of appropriate personal protective equipment, sterilization and disinfection procedures; and use of measures, such as high-volume suction, to minimize the spread of blood.
authors.affiliation: Dr. Radcliffe was with the Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, when the investigation described in this article was conducted. She now is a program manager, Division of Acute Disease Epidemiology, South Carolina Department of Health and Environmental Control, Columbia.
authors.forename: Rachel A
authors.initials: RA
authors.lastname: Radcliffe
authors.forename: Danae
authors.initials: D
authors.lastname: Bixler
authors.forename: Anne
authors.initials: A
authors.lastname: Moorman
authors.forename: Vicki A
authors.initials: VA
authors.lastname: Hogan
authors.forename: Vickie S
authors.initials: VS
authors.lastname: Greenfield
authors.forename: Diana M
authors.initials: DM
authors.lastname: Gaviria
authors.forename: Priti R
authors.initials: PR
authors.lastname: Patel
authors.forename: Melissa K
authors.initials: MK
authors.lastname: Schaefer
authors.forename: Amy S
authors.initials: AS
authors.lastname: Collins
authors.forename: Yury E
authors.initials: YE
authors.lastname: Khudyakov
authors.forename: Jan
authors.initials: J
authors.lastname: Drobeniuc
authors.forename: Barbara F
authors.initials: BF
authors.lastname: Gooch
authors.forename: Jennifer L
authors.initials: JL
authors.lastname: Cleveland
mesh_terms: D000328:Adult; D003428:Cross Infection / Q000453:epidemiology / Q000635:transmission*; D003740:Dental Clinics; D004196:Disease Outbreaks; D006509:Hepatitis B / Q000453:epidemiology / Q000635:transmission*; D006801:Humans; D008952:Mobile Health Units; D012189:Retrospective Studies; D012307:Risk Factors; D014903:West Virginia / Q000453:epidemiology
keywords: Dentistry; hepatitis B virus; infection control; outbreak; portable dental equipment